Children’s Environmental Health

200

Highlights

8

Environment, Health, 

And a Focus on Children

Children’s Environmental Health: 2008 Highlights 

2

Why focus on children?

Since its founding in 1970, EPA’s mission 

has been to protect human health and the 

environment. This report, eighth in an annual series 

from the Office of Children’s Health Protection and Environmental 

Education, highlights the Agency’s recent work on protecting the 

health of children by addressing the environments where they live, 

learn and play.

In the field of environmental protection, even and breathe more than adults in proportion to 

experts did not always recognize that children their body weight. Unclean food, water, and air 

are different from adults. Protective measures therefore is more threatening to their health. 

were first written with the average American Children also have unique exposure pathways, 

adult—not children—in mind. Calculating the such as through the placenta or breast milk.

environmental contribution to disease is an 

evolving field, and the question of how much Children play and learn by crawling, placing 

disease can be prevented through healthier their hands and other objects in their mouths—

environments is often asked. The World exploring the world with disregard for their 

Health Organization estimates that one- own safety. These developmentally normal 

quarter of the global disease burden is due to behaviors may lead to unintended exposure 

environmental factors. For children, that pro- to environmental hazards. For example, a 

portion rises to one-third. This burden is much small child may be exposed to lead by putting 

greater in developing countries, where infant fingers tainted with lead paint dust into her 

death from environmental causes is 12 times mouth. In addition, a child has little or no conhigher than in developed countries. Children trol over exposure, for example, to the secondencounter their environments differently than hand smoke of a nearby adult. An older child 

adults. Physically, their neurological, immuno- might play on fields treated with pesticides, or 

logical, respiratory, digestive, and other physi- sit day after day in a classroom contaminated 

cal systems are still developing and can be with mold allergens.

more easily harmed by exposure to environmental factors. Children eat more, drink more, 
Pl aces and spaces

 with kids in mind

Brownfields: EPA’s Brownfields Program issues related to site cleanup and urge 

began in response to community concerns sustainable redevelopment of brownfields. 

about blight, disinvestment, and environmental Grantees can expand parks, community garcontamination. In the 10-plus years since the dens and exercise paths, thereby providing for 

program’s inception, brownfields have been children. www.epa.gov/brownfields 

redefined. Properties that were shunned or 

eyed warily by those with the resources to Our Town: Involving youth is a new 

transform them are now viewed as opportuni- component of the Brownfields Program. 

ties for environmental and economic rebirth. In 2003, EPA provided funds to Purdue 

Communities with idle or abandoned properties University, in Lafayette, Indiana, to develop 

have options and resources to turn them into a program to educate youth about browncornerstones of positive change. EPA supports fields science and economics. The result 

brownfields reuse rather than strictly enforcing was the Our Town program, managed 

for the environmental mistakes of a property’s by Purdue’s Department of Engineering 

former owners. Education, which engages public school 

youth in brownfields-related activities, 

Local health departments are eligible for generating grassroots momentum for 

EPA brownfields grants and may use up communities to actively pursue economic 

to 10 percent of their value to monitor the development and improve quality of life. 

health of populations exposed to hazardous 

substances. Grantees can advocate for consideration of broader health and environmental 

Children’s Environmental Health: 2008 Highlights 

3
Children’s Environmental Health: 2008 Highlights 

4

In Hammond, Indiana, more than Smart Growth and Children’s 

180 students from seven schools, Health: In 2004, EPA funded five commuin grades 4–12, helped identify nity-based projects that make the connection 

12 brownfields within the historically between land use and children’s health. Over 

industrial city. Three of these properties the last few years, these grantees—ranging 

were eventually selected for further from WalkBoston to the Smart Growth for 

investigation, assessments, and Healthy Children program in Cocke County, 

reuse planning. Students identified Tennessee—have begun to demonstrate 

likely contaminants given the sites’ positive impacts in their communities. These 

histories, and confirmed the presence results represent a small but growing body 

of underground storage tanks. They of data and metrics that illustrate how, 

presented redevelopment options for the and to what extent, children can be active 

three properties at a community meeting, participants in improving the built environunveiling a plan to turn a former truck ments where they live. See the Journal of 

transportation property into a retail garden Public Health Management and Practice, 

and landscape center. By the following Volume 14 Number 3 (May–June 2008) for 

school year, Our Town had been replicated a summary of findings from these projects. 

in multiple schools in Kokomo, Lafayette, www.epa.gov/smartgrowth

and Indianapolis. Our Town is now being 

implemented at schools in Chicago, Vermont: Smart Growth Vermont 

Illinois; Philadelphia, Pennsylvania; Tucson, developed the Healthy Kids/Healthy 

Arizona; and Portland, Oregon. Further Neighborhoods program with assistance 

expansion is expected. from EPA to engage youth in community 

planning and revitalization. By evaluating 

From Brownfield to Children’s the health and safety of their neighborMuseum in Colorado: The city of hoods and initiating service-learning projDurango became home to the world’s first ects that address their findings, youth play 

steam-powered, alternating-current power key roles in solving community issues and 

plant in 1893. But the 8,000-square-foot become excited about learning. Involving 

site was boarded up in the 1970s and youth in decision making benefits everysat idle and dilapidated on the banks of one—youth, adults, and the community. 

the Animas River. In 2002, the Children’s 

Museum of Durango wanted to restore Massachusetts: The Concord River 

and relocate to the site. Public health and Greenway Park’s goal is to restore, mainenvironmental assessments were the first tain, and enhance the ecological integrity 

step, and the city and state worked with and social viability of the Concord River 

EPA’s Brownfields Program on assess- as it flows through the city of Lowell. 

ment and cleanup. Assessments found Through planning, the Concord River was 

asbestos, pigeon waste, mercury, and transformed from a boundary between 

uranium mining waste. Removal of asbes- neighborhoods into a shared natural 

tos and contaminated soil and a primary resource that unites and connects them 

cleanup of the facility followed. Now, at to broader regional resources. Children 

the new Children’s Museum, kids can were involved in the planning process and 

experiment with the 19th century sci- their input was invaluable in determining 

ences that gave rise to electrical power, the scope and extent of the project.

learn about locally mined energy, operate 

a hydrogen-powered race car, and explore 

energy-efficient building techniques. 
Smart Growth and School Siting: Examples of CARE Projects:

EPA and the National Trust for Historic 

Preservation are looking at state policies that Denver: Through Ground-Work Denver 

influence siting and construction of public and assistance from AmeriCorps, more 

schools. The aim is to identify and overcome than 100 at-risk 14 to17-year-olds 

state-level policy barriers to building commu- designed and worked on a citywide envinity-centered schools, which allow children to ronmental education program addressing 

walk to school and be physically active every children’s health. They collaborated with 

school day. Community-centered schools students from the Community College 

also reduce emissions from automobiles and of Denver to translate outreach materibuses. As part of the project, the trust will als on mercury hazards in the home into 

work with five states to analyze policies, con- Spanish, and then distributed these mateduct outreach and education, create a plan rials. Students also conducted home visits 

for reform, and publicize the opportunities and in low-income communities to encourage 

benefits that accompany better school siting parents not to smoke around children, and 

and construction. distributed EPA publications on children’s 

environmental health. 

Community Action for a Renewed 

Environment (CARE): This grant pro- Pennsylvania: Pennsylvania State 

gram helps communities address multiple University is partnering with local childsources of toxic pollutants in their environ- care centers and schools in Philadelphia 

ments. EPA works with local organizations to educate students, teachers, and 

to set priorities for risk reduction and cre- maintenance staff about the benefits 

ate self-sustaining, community-based part- of Integrated Pest Management (IPM), 

nerships that implement local solutions to reaching more than 1,000 people, garnerproblems posed by pollutants. Since 2005, ing more than 225 pledges to use safer 

EPA has provided nearly $8 million in grants pest-control practices, and providing inforto 48 communities in 25 states. Another mation in both English and Spanish. 

16 communities will receive grants in 2008. 

Many of these communities are focusing on Montana: Rocky Mountain College 

children’s health, making strides to reduce is working with partners to improve 

exposure to lead, mercury, and other chemi- the health of American Indian children 

cals. Among the many accomplishments: More through chemical removal and disposal 

than 1,300 homeowners received informa- in schools and Boys and Girls Clubs, and 

tion and assistance on lead paint testing, by conducting outreach to K-12 schools 

28 schools used EPA’s Chemical Cleanout or on lead exposure, asthma triggers, and 

Indoor Air Quality Tools for Schools (IAQ TfS) other environmental health issues. Visit 

programs to eliminate chemical hazards, and http://cobalt.rocky.edu/~CARE/ to learn 

the St. Louis, Missouri, city schools adopted more about the successes of CARE in 

no-idling zones to reduce exposure to vehicle Indian Country.

exhaust. www.epa.gov/care 

Children’s Environmental Health: 2008 Highlights 

5
Cl imate change and 

 children’s health

Children’s Environmental Health: 2008 Highlights 

6

U.S. Climate breathing rates relative to body size. They 

Change spend time outside, often in active recreation, 

Science Program and their developing immune systems can 

(CCSP): The CCSP is a make them more susceptible to water- and 

multi-agency effort focused on improving our food-borne diseases. There is also some eviunderstanding of the science of climate change dence that children are susceptible to psychoand its potential impacts. Climate change, logical impacts, such as post-traumatic stress 

interacting with changes in land use and demo- disorder, associated with extreme weather 

graphics, has the capacity to affect important such as floods. See more information about 

human dimensions, especially human health, children’s health and climate change at 

human settlements, and human welfare. A report http://yosemite.epa.gov/ochp/ochpweb.nsf/

by EPA, coordinated with CCSP, Synthesis content/climate.htm

and Assessment Product 4.6: Analyses of the 

Effects of Global Change on Human Health North Carolina Kids Fight Climate 

and Welfare and Human Systems, was released Change: EPA Region 4 (Alabama, Florida, 

recently. www.climatescience.gov/Library/sap/ Georgia, Kentucky, Mississippi, North Carolina, 

sap4-6/final-report/ South Carolina, and Tennessee) presented 

a program to Durham Middle School on cliClimate change’s projected effects include: mate and energy. The school gathered more 

than 2,000 pledges to install 6,000 compact 

• greater frequency of heat waves fluorescent lamps. The school’s commitments are responsible for eliminating nearly • increased variability of precipitation 2.5 million pounds of carbon dioxide. The 

• changes in minimum and maximum school has become an active environmental 

temperatures advocate and has formed an environment club. 

www.energystar.gov • sea-level rise

• increased intensity of tropical storms New Jersey Earth Day: EPA Region 

3 (Delaware, District of Columbia, Maryland, • more droughts Pennsylvania, Virginia, and West Virginia) 

• more coastal and riverine flooding worked with third to sixth graders to explore 

how daily activities affect the environment. In 

Direct and indirect impacts to health and well- the fifth-grade class of Hillside Intermediate in 

being can include morbidity and mortality asso- Bridgewater, New Jersey, 22 students decided 

ciated with heat waves and extreme weather to reduce the carbon footprint of their school 

events, changes in the range and incidence of by recycling and eliminating use of single-use 

vector- and water-borne diseases, exacerbation plastic water bottles. The students developed 

of air pollution and aeroallergens, contaminated a design for a reusable school water bottle. 

food and water, and impacts on mental health. Proceeds from the bottle sales were used 

to buy recycling bins for the playgrounds. 

Children are more vulnerable to the health The class reduced the amount of single-use 

impacts of climate change, mainly due to plastic water bottles students were using by 

physiological differences between children and 80 percent, resulting in savings of 26 gallons 

adults. Children have a smaller body mass to of gasoline, and one barrel of oil. The students 

surface area ratio than adults, making them plan to continue their efforts in the upcommore vulnerable to heat-related morbidity and ing school year, with the goal of 100 percent 

mortality. They are more vulnerable to air pol- use of the school water bottle. www.epa.gov/

lution’s health effects due to their increased reg3esd1/childhealth/projects.htm.
Pr otecting children

 where they learn

Air Quality in Schools: According to project supports training workshops for custoa survey by the Centers for Disease Control dians and provides Web-based tools for stuand Prevention, more than half of the nation’s dents, families, and staff. Nearly 90 percent of 

schools are now implementing indoor air qual- all public schools in Connecticut are participatity management programs. The study also ing, and reduced absenteeism and improved 

determined that 86 percent of those schools health in schools are well documented. In 

based their efforts on EPA’s IAQ TfS program, Vermont and New Hampshire, exemplary 

which is designed to reduce asthma attacks, school districts are chosen as mentors to 

bronchitis, and other respiratory ailments, as other school districts to implement TfS. 

well as increase performance and productivity of students and staff. Key components HealthySEAT: In 2007, EPA offered 

of IAQ TfS include outreach and educa- an enhanced version of its free, fully custion, training, and recognition opportunities. tomizable Healthy School Environments 

www.epa.gov/iaq/schools Assessment Tool (HealthySEAT) to help 

school districts establish voluntary selfEPA has worked with the Connecticut assessment and prevention programs coverDepartment of Public Health for the past five ing every facet of school health and safety. 

years to address indoor air quality by imple- www.epa.gov/schools/healthyseat

menting and sustaining IAQ TfS in public 

schools. Partners have provided training to The Ohio School Environmental Health and 

more than 500 schools, with a special focus Safety Inspection Rules, also known as 

on Hartford, New Haven, and Stamford. The “Jarod’s Law,” went into effect in September 

Children’s Environmental Health: 2008 Highlights 

7
Children’s Environmental Health: 2008 Highlights 

8

2007. The law, named for a six-year-old killed No Idle Zones: Idle-reduction proin a school accident, is designed to protect grams have started statewide in Florida, 

and improve the environmental health and North Carolina, and South Carolina. 

safety of Ohio’s primary and secondary school EPA Region 4 has supported more than 

students and staff. Jarod’s Law requires 135 bus retrofit programs impacting more 

experts from local health departments to than 11,300 school buses, and supports 

annually inspect the school buildings and wider use of biodiesel, hybrid, or electric 

associated grounds within their jurisdictions to school buses. 

identify health and safety concerns. Recently, 

HealthySEAT was customized to include all Better Buses: Students in Baltimore 

Jarod’s Law requirements. www.odh.ohio.gov/ City Public Schools in Maryland will soon 

odhPrograms/eh/schooleh/sehmain.aspx breathe cleaner air. An EPA grant will help 

the school system reduce diesel pollution 

Clean School Bus USA: Every by retrofitting 19 diesel-powered school 

school day, 450,000 school buses trans- buses with pollution control technologies. 

port 25 million students to and from school, A second grant will support developsporting events, and other functions. Each ment of an indoor air quality program in 

year, those school buses emit tons of diesel 190 school buildings. Personnel at various 

exhaust that causes soot and smog and trig- levels will be trained to identify, recognize, 

gers asthmatic episodes. Since its launch in and develop solutions to reduce exposure 

2003, EPA’s Clean School Bus USA program of building occupants to indoor pollutants.

has worked to reduce children’s exposure to 

diesel exhaust by reducing the pollution cre- Massachusetts Facility 

ated by school buses. As a result, more than Administrators Association (MFAA):

2 million students are riding cleaner buses. An Over the past few years, MFAA, through a 

estimated 40,000 buses are using emission cooperative agreement with EPA’s Region 1 

reduction technologies and cleaner fuels, and (Connecticut, Maine, Massachusetts, New 

school districts across the United States are Hampshire, Rhode Island, and Vermont), has 

implementing idle-reduction programs, reduc- been developing and delivering an environing air pollution and saving money on fuel. mental health and safety training program 

www.epa.gov/cleanschoolbus for school facility managers across the state. 

Massachusetts is one of the first states to 

Learning About Diesel: The Clean offer an accredited training program for school 

School Bus USA program partnered with facility managers. The program received recScholastic Inc. to publish a new book in ognition during EPA’s Environmental Merit 

the popular Magic School Bus children’s Award ceremony on Earth Day 2008. 

series. In The Magic School Bus Gets 

Cleaned Up, the children and Ms. Frizzle Healthier Illinois Schools: A new 

explore the pollution emitted from their state law requires elementary and secondary 

own school bus and learn how to reduce schools, both public and private, to purchase 

the emissions as they travel through a and use only environmentally sensitive cleandiesel engine. The children learn about ing supplies. Only products that meet specific 

idle reduction and ways the community standards, such as those of EPA’s Design for 

can help reduce health risks from die- the Environment Program, may be used. This 

sel exhaust. At the end of the book, the makes Illinois the second state (after New 

magic bus gets its own pollution control York) to require purchase and use of environdevice, a particulate-matter filter. mentally sensitive cleaning supplies in schools. 

EPA Region 5 (Illinois, Indiana, Michigan, 
Children’s Environmental Health: 2008 Highlights 

9

Minnesota, Ohio, and Wisconsin) helped plant Children’s Health Initiative in 

some of the seeds of green cleaning in Illinois Region 2: Through this four-year effort, 

by funding a pilot project with the Healthy EPA Region 2 (New Jersey, New York, Puerto 

Schools Campaign, working with Chicago Rico, and U.S. Virgin Islands) has protected 

Public Schools, and supporting a sustainable 286,700 children from hazardous materials 

schools project. www.standingupforillinois.org/ by helping schools identify and address envigreen/school_cleaning.php ronmental concerns. Through integration of 

the drinking water, asbestos, pesticides, and 

Chemical Cleanout Campaign: The hazardous waste programs, EPA is focusing 

Schools Chemical Cleanout Campaign inven- on K-12 school systems in specific communitories and removes outdated and potentially ties to ascertain the status of testing drinkharmful chemicals from schools; conducts ing water for lead in schools and to review 

educational workshops for teachers on safe compliance with hazardous waste regulachemical management, lab safety regulations, tions. In Trenton, New Jersey, EPA collected 

and chemical waste disposal; and promotes 568 drinking water samples from 10 elemengreen chemistry. www.epa.gov/sc3 tary schools. Test results, then remediation, 

are the next steps. www.epa.gov/region02/

In New Hampshire, Plymouth State University children/index.html

is conducting a Supplemental Environmental 

Project (an environmentally beneficial effort 

that a violator performs in lieu of payment of 

a portion of a penalty) to assist K-12 schools 

with chemical management practices, including staff training and waste removal. 

Tribal Schools: EPA is reducing the health 

risks from exposure to hazardous waste, laboratory chemicals, pesticides, and asbestos 

by improving compliance at schools in Indian 

Country, where approximately 460,000 children and staff spend their days. These schools 

are often challenged by a need for ongoing 

and consistent environmental management 

and maintenance programs. EPA developed 

comprehensive, Indian Country–specific material and widely distributed the Tribal Schools 

Compliance Assistance Notebook. From 

2005 to 2007, EPA conducted compliance 

monitoring inspections at 128 schools. A summary of EPA’s efforts is available at www.epa.

gov/compliance/data/planning/priorities/

tribal.html, and the notebook is available at 

http://yosemite.epa.gov/R10/TRIBAL.NSF/

Programs/Tribal+Schools.
Asthma

Asthma is a complex chronic disease affecting millions of people in the United 

States, including 6.5 million children. The burden of asthma is great: Emergency 

room and hospital visits, missed school days, and missed work days, all contribute 

to an estimated annual national cost of $19 billion. 

Communities Addressing Asthma: meet annually at the EPA-sponsored National 

290 community-based asthma programs Asthma Forum, which provides events 

have joined the EPA Communities in Action throughout the year for community leaders 

for Asthma Friendly Environments Network. to accelerate adoption of best practices for 

Participants pursue strategies to achieve asthma care. This year, a pre-forum workshop 

positive health outcomes, including cultivating focused on building a business case for comprogram leaders, establishing sound com- prehensive asthma management that includes 

munity relationships, maximizing cooperative patient education and environmental manageopportunities, providing integrated health care ment. www.asthmacommunitynetwork.org 

services, and implementing tailored environmental interventions. The network is supported Heartland Tackles Asthma: EPA 

by an interactive Web site that provides edu- Region 7 (Iowa, Kansas, Missouri, and 

cation, communication, and resource sharing. Nebraska), in partnership with the American 

The network and supporting organizations Lung Association of the Central States, hosted 

Children’s Environmental Health: 2008 Highlights 

10
Children’s Environmental Health: 2008 Highlights 

11

the first-ever Heartland Region Asthma Innovative Asthma Programs: In 

Forum, in Omaha, Nebraska. A comprehensive 2008, EPA selected three organizations 

agenda covered the new National Guidelines for the National Environmental Leadership 

for the Diagnosis and Management of Asthma, Award in Asthma Management. The award 

EPA Communities in Action for Asthma recognizes health plans and health care proFriendly Environments initiative, and work- viders who have demonstrated leadership in 

shops on indoor environmental assessments managing environmental triggers as part of a 

and outdoor air quality. comprehensive asthma management program, 

and who are improving the health of children 

Southwest Asthma Advances: they serve. Award winners serve as mentors 

Through grants, organizations throughout EPA and models for best practices in asthma care. 

Region 6 (Arkansas, Louisiana, New Mexico, www.epa.gov/asthma

Oklahoma, and Texas) are training children 

and their families to reduce environmental 2008 Winners are:

asthma triggers. In Oklahoma, 186 children 

were trained on how to reduce environmental Monroe Plan of Rochester, 

asthma triggers through the Pawnee Health New York: The Monroe Plan covers 

Clinic. Along the Texas/Mexico border, more 5,633 children with asthma in Monroe 

than 75 health Promotoras were trained. In County and 12 neighboring rural counties. 

Arkansas, New Mexico, and Texas, 17 school In partnership with ViaHealth, a health 

nurses, 72 families, 44 health care profes- care delivery system, the plan launched 

sionals, and 211 child care providers have a program to shift asthma care away 

been trained this year. In rural East Texas, from emergency services and inpatient 

30 children were treated by the Region 6 care and toward improved patient selfPediatric Environmental Health Specialty Unit management. The program now covers all 

(PEHSU)—the Southwest Center for Pediatric plan members with moderate to severe 

Health—in the Breath of Life, a mobile asthma pediatric asthma and includes assistance 

education and treatment van. to health care providers. Asthma action 

plans, education, and home assessments 

Arresting Asthma Triggers: Make the helped reduce emergency room visits 

Road by Walking is a community organiza- from 1.1 per person to 0.95 visits per 

tion in Brooklyn, New York, that is raising person over the first three years of the 

awareness about children’s asthma triggers. program. Inpatient admissions decreased 

EPA provided a cooperative agreement to from 98.3 per 1,000 to 84.15 per 1,000 

benefit the Bushwick neighborhood, where in the first three years.

children suffer from the old housing stock 

and lack of information on how to avoid University of Michigan Health 

exposure to asthma triggers. Many of the System, Ann Arbor, Michigan:

residents are renters and require landlords to This health system is a nonprofit health 

make repairs and maintain units. The project care provider serving 12,214 adults and 

reduced exposure to asthma triggers by edu- children with asthma in four counties 

cating more than 1,200 residents, providing in southeastern Michigan. The program 

extended hours for asthma treatment services, includes in-home asthma education 

expanding local partnerships, and convening through the Michigan Visiting Nurses 

a new coalition of 10 community groups to Asthma Home Environmental Assessment 

influence policy. www.epa.gov/compliance/ Program. This award winner achieved a 

environmentaljustice/grants/ej-cps-grants.html 50 percent decrease in asthma-related 
Children’s Environmental Health: 2008 Highlights 

12

hospitalizations from July 2005 to June commercial advertising on measures of con2007. Between June 2006 and June sumer likability; engaging and empowering 

2007, the program had a 60 percent families, especially African-American and 

decline in emergency room visits and Hispanic families; promoting asthma manage85 percent fewer hospitalizations. ment behaviors; calls to the hotline; and visits 

to the Web site for asthma education informaThe Asthma Network of West tion. The Chris Draft Foundation joined the 

Michigan, in Grand Rapids, is a goldfish campaign in 2008, and Draft himself, 

community coalition that provides a professional football player, is featured in 

comprehensive home-based case radio announcements. www.noattacks.org 

management to 94,500 children and 

adults with asthma in western Michigan. Asthma Health Outcomes Project:

Results include improved health out- The project is a landmark study sponsored 

comes and cost savings. This success by EPA to understand asthma disparities and 

has led to a partnership with Priority determine how communities can best improve 

Health (a winner of the 2007 National health outcomes of people with asthma. EPA 

Environmental Leadership Award in and the Centers for Disease Control and 

Asthma Management), which agreed to Prevention’s National Center for Environmental 

reimburse the network for its home visit Health (NCEH) coordinated a successful halfprogram. The partnership is the nation’s day workshop at Meharry Medical College 

first between a grassroots coalition and in Tennessee and a seminar at Morehouse 

managed care plan. The network has School of Medicine in Georgia, where more 

contracts with five local health plans, than 185 faculty, students, and health care 

and its asthma management program professionals were educated about asthma.

provides asthma education, coordination 

with health care providers, development 

of asthma action plans, home environmental assessments, and social service 

support. This comprehensive care has 

led to a 64 percent decrease in hospitalizations and 60 percent decrease in 

emergency room visits. These improved 

health outcomes resulted in approximately 

$800 in net health care cost savings per 

child per year.

Goldfish Media Campaign: The 

National Childhood Asthma Public Service 

Media Campaign, a collaboration between 

EPA and the Ad Council, uses the imagery 

of a goldfish out of water to convey the message of urgency and provides tips for parents 

to help manage asthma triggers, such as 

making their homes smoke-free and controlling mold and dust mites. The Ad Council 

recently conducted a study to determine the 

ads’ effectiveness. The campaign outscored 
Safe in the sun

SunWise Communities: With more than • The city of Boston has pledged to plant 

1 million people diagnosed with skin cancer 100,000 trees by 2020, increasing its 

each year, teaching children to be safe in the canopy cover by 60 percent.

sun is an important step toward decreasing 

the incidence of this preventable disease. • Recent statistics on skin cancer indiSince sun damage is cumulative and protec- cate that Cobb County, Georgia, has a 

tion is best if started early, EPA’s SunWise 51 percent higher incidence of melanoma 

Program works to improve children’s sun than the national average. In response, the 

safety knowledge, attitudes, and behavior. A county has distributed SunWise kits to all 

recent study published in Pediatrics (vol. 121 its schools and provided education about 

no. 5) found that SunWise efforts between overexposure to ultraviolet rays.

1999 and 2015 should prevent more than 

50 premature deaths and 11,000 cases of • Washington State built on previous 

skin cancer in the United States, resulting in SunWise efforts in King and Pierce 

a $2–$4 savings in public health costs for Counties to become the third state to push 

every federal dollar invested. In addition to for sun safety in its schools. Washington 

the more than 21,000 schools and informal has the fifth highest melanoma incidence 

education organizations now signed up with rate and seventh highest death rate in the 

SunWise, three more areas became SunWise country. Melanoma occurs almost as freCommunities this year. www.epa.gov/sunwise quently in the cloudy and rainy part of the 

state as the sunny and dry eastern part.

Children’s Environmental Health: 2008 Highlights 

13
The air they breathe

Children’s Environmental Health: 2008 Highlights 

14

Ozone Outdoor Wood Heaters: EPA has also 

Standard: On developed a voluntary program that is helpMarch 12, 2008, EPA ing to bring cleaner outdoor wood heaters to 

announced a new eight-hour market. These heaters, also known as outdoor 

standard for ozone. The new primary eight-hour wood boilers, look like a small shed with a 

standard, which sets limits to protect public smokestack, typically located on the outside 

health, including the health of sensitive popula- of the building to be heated. They burn wood 

tions such as asthmatics, children, and older to heat water that is piped underground to 

adults, was changed from 0.080 parts per provide heat and hot water to homes, barns 

million to 0.075 parts per million. Benefits for and greenhouses. The heaters are mostly 

children’s health include preventing some cases used in rural, cold climates where wood is 

of bronchitis and aggravated asthma, decreas- readily available; however, they can be found 

ing hospital and emergency room visits, and throughout the United States. EPA encourreducing school absenteeism due to respiratory ages manufacturers to produce cleaner modillness. www.epa.gov/groundlevelozone els, encourages users to buy the cleanest 

models available, and educates users on the 

Smoke-Free Homes for Head Start health effects of woodsmoke. New heaters 

Children: Exposure to secondhand smoke that qualify for EPA’s program are at least 

can cause middle ear infections, bronchitis, 70 to 90 percent cleaner than existing units. 

pneumonia, decreased lung function, sud- www.epa.gov/woodheaters

den infant death syndrome, and can worsen 

asthma. A 2007 Surgeon General’s report, Reducing Children’s Exposure to 

reaffirmed that there is no safe level of sec- Household Smoke: More than half the 

ondhand smoke. Millions of young children world’s population relies on solid fuels (e.g., 

continue to be exposed to it in their homes. wood, dung, crop residues, and coal) for 

everyday cooking and heating needs, filling 

EPA and the U.S. Department of Health and homes with harmful particulate matter, carbon 

Human Services (DHHS) are improving the monoxide, and toxic smoke. Among children 

quality of life for nearly 1 million Head Start chil- younger than five, breathing unsafe levels 

dren through sec ondhand smoke and asthma of this smoke more than doubles the risk of 

outreach efforts. Head Start teachers, staff, and acute lower respiratory infections. Worldwide, 

parents will create smoke-free, asthma-friendly such infections continue to be the biggest 

homes using tools and resources from the agen- killer of young children, causing more than 

cies. www.epa.gov/smokefree 2 million deaths annually and accounting for 

19 percent of deaths in children under five. 

Residential Wood Smoke: EPA’s Great The Partnership for Clean Indoor Air, launched 

American Woodstove Changeout campaign is by EPA in 2002, is tackling this issue by introfacilitating replacement of older, dirtier wood- ducing safer, cleaner burning, fuel-efficient 

stoves and fireplaces with new, cleaner burn- cooking and heating technology. Today, more 

ing appliances such as masonry heaters and than 170 public and private sector partgas-fueled, pellet-fueled, and EPA-certified ners are working in 67 countries to improve 

stoves. Particle pollution, such as the particles health by reducing household air pollution. 

in wood smoke, can be harmful to children. This effort has helped more than 1.4 million 

Since 2005, the program has replaced more households adopt clean and efficient cookthan 7,500 woodstoves and fireplaces, avoid- ing and heating practices. Partners aim to 

ing nearly 200 tons of particle pollution and reach another 6 million households by 2010. 

realizing an estimated $50 million per year in www.pciaonline.org

health benefits. www.epa.gov/woodstoves
Pr otecting children from 

 pests and pesticides

Public Health and Urban Pests: The Integrated Pest Management (IPM) 

spread of mosquito- and tick-borne diseases Promotes Healthier Schools: EPA 

in Europe and North America and the asthma recommends that schools use IPM to reduce 

epidemic in industrialized nations have sig- pesticide exposure to children. IPM is a safer 

naled the need to carefully assess the threat and usually less costly option than convenof urban pests to public health. According to tional pest management. IPM programs use 

the World Health Organization (WHO), asthma common sense strategies to reduce sources 

attacks are triggered by an allergic response of food, water, and shelter for pests in and 

in 50 percent of adults and in 80 percent of around buildings, and encourage careful use 

children with asthma. In urban areas, sensitiza- of pesticides. More than 20 percent of schools 

tion to pests, including rodents, cockroaches, use IPM. EPA’s goal is to have all schools on 

and dust mites, is common among asthmat- board by 2015. www.epa.gov/pesticides/ipm

ics. EPA supported a WHO project in which 

international experts in pest-related fields In Indiana, the Monroe County Community 

provided evidence for policies to address this School Corporation’s IPM program was 

public health problem. These experts identi- developed in the mid-1990s and has 

fied the public health risks posed by various been replicated in 10 states. This program 

pests and measures to prevent and control boasts a 90 percent reduction in pesticide 

them, and in 2008 WHO published the book use, pest problems, and pest-control costs. 

Public Health Significance of Urban Pests

(www.euro.who.int/document/e91435.pdf). In Utah, the Salt Lake City School District 

became the nation’s 28th school district to earn the IPM Institute of North 

Children’s Environmental Health: 2008 Highlights 

15
Children’s Environmental Health: 2008 Highlights 

16

America’s IPM STAR® certification fol- Recognizing IPM Leaders: EPA suplowing a rigorous, 37-point inspection. ports the IPM Institute’s IPM STAR certifiBoth pesticide applications and pest cation program, which provides incentives 

occurrences have dropped by more than to reduce pests and pesticide risks to chil90 percent since the district’s program dren’s health. Certification clearly establishes 

began. EPA Region 8 (Colorado, Montana, competence in a way that is recognized by 

North Dakota, South Dakota, Utah, and others. Applicants undergo careful on-site 

Wyoming) provided funding for the effort. evaluations of their IPM programs. To date, 

practitioners in more than 35 school disIntegrated Pest Management (IPM) tricts and child-care centers are certified and 

In Section 8 Housing: A partnership more are waiting to go through the process. 

between EPA and the Department of Housing http://ipminstitute.org/school.htm

and Urban Development is bringing IPM to 

families living in Section 8 housing (a federal Safer Rodent Control: In May, 

program that provides housing assistance to EPA announced new safety measures for 

eligible low-income renters and homeowners) 10 rodent-control products. Rodent-control 

through a pilot program called the Market-to- pesticides, or rodenticides, are an important 

Market Green Incentives Initiative. This pro- tool for public health pest control, including 

gram provides financial incentives for property controlling mice and rats around the home. 

owners to green their rehabilitation and main- However, these products have been associtenance practices, including a requirement for ated with accidental exposures to thousands 

switching from conventional, chemical-focused of children each year. Rodenticides marketed 

pest management to prevention-oriented IPM to consumers must be enclosed in bait stastrategies. The program is expected to reach tions, making them inaccessible to children. 

about 2,400 Section 8 developments over the Loose bait, such as pellets, is prohibited for 

next five years, involving about half a million use in homes. Data indicate that children in 

low-income residents. The potential health low-income families are disproportionately 

benefits of reducing exposure to pests and exposed to rodenticides. http://epa.gov/

pesticides are significant—50 percent of resi- pesticides/reregistration/rodenticides/

dents report at least occasional cockroaches 

or rodents and 10 percent report always hav- Latino Outreach to Prevent 

ing cockroaches or rodents. Research into Pesticide Poisoning: An outreach camallergic asthma shows a strong correlation paign during National Poison Prevention Week 

between allergies to cockroaches and asth- targeted Latino families and reached 32 milmatic response. Most allergic asthma sufferers lion people in the United States and Latin 

are children in low-income urban areas. America with the message “Children act fast, 

and poisons do, too!” American Association of 

Reducing Pesticide Exposure in Poison Control Centers (AAPCC) data show 

Child Care Centers: This year, EPA and that more than 50 percent of the 2 million 

DHHS’ Office of Head Start launched a national incidents of exposure to chemicals and other 

pesticide awareness campaign called Play It materials each year involve children younger 

Safe. The campaign features a suite of outreach than six, with 90 percent of calls concerning 

materials, available in English and Spanish, tar- home exposures. EPA’s Pesticides Hispanic 

geting Head Start parents and staff. Training Outreach Initiative reduces exposure risk by 

for 250 child-care employees serving more showing how to minimize exposure, defining 

than 1,500 children was provided in 2008 by the symptoms of pesticide poisoning, and prothe Pennsylvania Integrated Pest Management viding information on where to get help. 

Program (PA IPM). PA IPM is training staff of 

Philadelphia’s Latino child care facilities.
Kee ping children 

 lead-free

Reducing Lead Poisoning: Children The rule will be fully effective in April 2010. 

are exposed to lead most often through www.epa.gov/lead/pubs/renovation.htm

unintentional ingestion of lead-containing 

particles, such as paint dust or contaminated Lead Grants:

soil. Under the 1992 Residential Lead-Based 

Paint Hazard Reduction Act, EPA estab- • In 2007, EPA provided more than $3 million 

lished training and certification rules and through the National Community-Based 

standards for lead in paint, dust, and soil. In Lead Grant Program to educate those 

April 2008, EPA issued a new rule aimed at at risk, provide lead awareness training, 

protecting children from lead paint hazards. and develop local ordinances aimed at 

The Lead Renovation, Repair, and Painting lead abatement in communities with older 

Program rule (40 CFR Part 745) requires housing. Grant recipients include city health 

contractors and construction professionals to departments, colleges and universities, 

be certified and to use lead-safe work prac- community organizations, religious groups, 

tices during renovation, repair, and painting and other nonprofit organizations.

in pre-1978 housing and child-care centers, 

pre-schools, and kindergartens. The rule • The Targeted Lead Grant Program funds 

also requires contractors to provide a new projects in areas with high numbers of 

lead hazard information brochure to property children with elevated blood lead levels. In 

owners, tenants, and owners and operators 2007, EPA awarded $5.2 million in grants to 

of buildings that have child-occupied facili- address immediate needs of communities 

ties, as well as to the parents and guardians and highlight model lead-poisoning 

of children under age six using the facilities. prevention strategies.

Children’s Environmental Health: 2008 Highlights 

17
Children’s Environmental Health: 2008 Highlights 

18

• EPA awarded nearly $1 million in Boston, Massachusetts, Lead 

grants to 15 tribes to reduce the Campaign: EPA Region 1 (Connecticut, 

incidence of childhood lead poisoning Maine, Massachusetts, New Hampshire, 

and support educational outreach and Rhode Island, and Vermont) seeks to end 

baseline assessments of exposure. childhood lead poisoning in Boston by 2010. 

www.epa.gov/oppt/lead/ The Lead Action Collaborative includes Tufts 

University and other public, private, nonprofit 

Less Lead, More Water: Drinking and housing organizations and increases viswater is also a source of lead exposure in ibility of the issue, creates strong lead policies 

children. EPA is addressing lead in drink- and regulations, and targets enforcement 

ing water in school and child-care facilities and outreach to reduce risk to children. This 

by developing tools and guidance. These coordinated effort has produced impressive 

materials encourage voluntary lead reduc- results: The number of lead-poisoned children 

tion programs and help school officials and in Boston dropped from 1,123 in 2001 to 

child-care providers minimize lead in drinking 362 in 2007.

water. To date, more than 1,300 toolkits, 730 

school guides, 3,900 child-care facility guides, Flakes Play in North Carolina: 

and 1,300 DVDs have been distributed. The Durham Affordable Housing Coalition 

www.epa.gov/safewater/schools conducted a public education project, Lead 

Safe...For Our Children’s Sake, to reduce 

Getting the Lead Out of Pacoima: childhood lead poisoning. Targeting AfricanThe community of Pacoima, California, used a American and Latino families living in high-risk 

$100,000 grant from EPA to reduce exposure homes, this effort resulted in “Flakes Play,” 

to lead paint and increase blood lead testing a musical production about lead-poisoning 

for children at risk. Many of the 22,035 homes prevention produced by the Walltown 

in this high-density, low-income, mostly Latino Children’s Theater. The play has heightened 

community are more than 30 years old and public awareness of the dangers of lead and 

still contain lead paint. Pacoima Beautiful, a how to prevent lead poisoning in children, 

community organization, partnered with local especially in vulnerable, low-income families. 

organizations and trained them to work with www.epa.gov/lead/pubs/lppwregion.htm#4

residents to raise awareness of the risks of 

lead paint, the importance of lead testing in 

children, and the need for home testing and 

abatement. The program tested 675 children 

for blood lead levels, provided information 

to 2,500 residents on safe cleaning practices and other simple measures to reduce 

lead levels, and tested 300 homes for contamination. Of those homes, 31.4 percent 

exceeded the lead dust criteria for floors and 

windows. Of those that exceeded the criteria, 

27 percent have been renovated or referred to 

free services or low-interest loans to remove 

the lead hazards. www.epa.gov/compliance/

environmentaljustice/grants/ej-cps-grants.html
Children and chemicals

Toxicity and collaborating with academics and other federal 

Exposure agencies to collect and analyze data on chilAssessment for dren’s exposures. These efforts allow EPA sciChildren’s Health (TEACH): entists to understand what chemicals children 

TEACH is EPA Region 5’s (Illinois, Indiana, are exposed to in their everyday environments, 

Michigan, Minnesota, and Wisconsin) 10-year what the sources of those chemicals are, what 

effort to consolidate and summarize current the most important exposure factors are, and 

peer-reviewed scientific literature published how exposures and risks can be reduced. 

since 1972. TEACH focuses on a subset www.epa.gov/nerl 

of chemicals relevant to children’s environmental exposure and toxicity. The project is Mercury, PCBs, and Fish in New 

Web-based and has two major components: a York and New Jersey: An estimated 

searchable database and chemical summaries. 16 percent of women of reproductive age in 

The database is used to search summaries of the United States eat fish at least once per day. 

literature on children’s exposure and toxicity. While a good source of protein, studies show 

The chemical summaries highlight information some fish and shellfish contain mercury, PCBs, 

from the database and other sources, such pesticides, and other harmful contaminants at 

as EPA’s Integrated Risk Information System. levels that can result in pre- or postnatal impairTEACH currently provides information for ments. New York City’s Health and Nutrition 

18 chemicals or chemical groups, including Examination Survey biomonitoring study 

arsenic, benzene, formaldehyde, three forms revealed that New Yorkers have more than 

of mercury, and polychlorinated biphenyls three times the national average of mercury in 

(PCBs). www.epa.gov/teach their blood. One-quarter of the 1,811 New York 

residents tested had blood mercury concentraChildren’s Exposures to Chemicals tions at or above the 5 ug/L New York State 

In Their Everyday Environments: reportable level. The study also found that forResearchers in EPA’s National Exposure eign-born Chinese residents had blood mercury 

Research Laboratory continue to work to concentrations more than two and a half times 

develop, refine, and validate analytical meth- that of the general population in the city. 

ods for different classes of chemicals found Although the fish species commonly associin children’s everyday environments, including ated with the highest levels of mercury are not 

brominated flame retardants, perfluorinated seen frequently in Chinese kitchens, the study 

chemicals, and current-use pesticides. A num- found that Chinese-Americans eat fish three 

ber of manuscripts have been published in times more often than others in the city. www.

peer-reviewed literature, including articles on ehponline.org/docs/2007/10056/abstract.html

methods for measuring pesticides in house 

dust, lead in paint, and perfluorinated chemi- In response to the findings, EPA funded two 

cals in house dust, soil, water, and fish. Data public health projects. The first project will 

analysis has been performed and published in develop a geographic information system 

the scientific literature for a number of recent (GIS) tool to identify areas in New York and 

studies. Recently published manuscripts New Jersey where women of child-bearing 

have reported on sources and pathways of age are at highest risk of eating contaminated 

exposure, important exposure factors, and fish. The second project will determine merrelationships of environmental measurements cury and PCB levels in fish species most comto biomonitoring results. EPA researchers are monly sold in the New York City area. This will 

Children’s Environmental Health: 2008 Highlights 

19
Children’s Environmental Health: 2008 Highlights 

20

provide an effective way to reach vulnerable Understanding Chemical 

populations. The second project involves fish Exposures: EPA’s Voluntary Children’s 

testing from the largest wholesale market in Chemical Evaluation Program (VCCEP) is 

the United States. An exciting and innovative designed to evaluate hazards, exposures, and 

aspect of the testing is using DNA coding for risks of chemicals to children, and to develop 

accurate species identification. Both studies information needed to assess these risks. 

are anticipated to improve targeting of future Companies that manufactured or imported 

outreach efforts. 20 of 23 chemicals to which children have a 

high likelihood of exposure have committed 

Reducing and Eliminating Mercury to provide EPA with information on health 

Use and Exposure: Mercury is contained effects, exposure, risk, and data needs. The 

in some products, such as thermostats, ther- information provided to date on 15 chemimometers, and barometers, that are commonly cals, their subsequent reviews, and related 

found in homes, health care facilities, and Agency decisions are provided on the Web 

schools. If these products break, toxic mercury site (www.epa.gov/oppt/vccep/). After convapors can be inhaled. EPA is taking action to ducting an interim evaluation of the program, 

reduce and eliminate mercury in products by EPA is considering using a modified VCCEP 

developing information on safer alternatives, approach to follow up on chemicals of interworking with states to reduce use of mercury est in its new Chemical Assessment and 

in products and promote mercury-containing Management Program, which assesses and 

product collection and recycling, developing initiates action on more than 6,750 indusregulations to reduce re-introduction of dis- trial chemicals manufactured in quantities of 

continued products, and working with other 25,000 pounds or more. www.epa.gov/champ/

federal agencies on short- and long-term 

management of surplus elemental mercury 

supplies. EPA is also working with other countries and the United Nations Environment 

Program to address risks associated with 

mercury uses, releases, and exposure internationally. EPA is working with Argentina, China, 

Costa Rica, and Mexico to reduce mercury 

in hospitals; and with Burkina Faso, Chile, 

Ecuador, Mexico, Panama, and South Africa 

to conduct mercury product inventories, market studies, and risk management projects. 

http://epa.gov/mercury/

Fish Consumption Information:

EPA’s National Fish Advisory Program 

recently released a new Fish Kids Web site 

(www.epa.gov/fishadvisories/kids/) that 

teaches kids about contaminants in fish and 

fish consumption advisories using fun, interactive stories and games. The Web site is 

designed for kids ages 8–12 and is best used 

with an adult. Whether they buy fish or catch 

their own, kids and their families can use this 

site to learn how to choose fish wisely.
Children’s Environmental Health: 2008 Highlights 

21

En vironmental 

health indicators

America’s (μg/dL) in 1976–1980 to 1.6 μg/dL in 

Children and The 2003–2004, a decline of 89 percent.

Environment is a leading source of information on envi- • In 2006, 9.3 percent (6.8 million) of all 

ronmental factors related to the health and children had asthma.

well-being of children in the United States. 

The Web site and reports present data on International Children’s 

levels of contaminants in the environment Environmental Health Indicators:

that can affect children’s health, and on EPA has been working with WHO and other 

childhood illnesses that can be influenced organizations to promote development of 

by exposure to contaminants. Data are children’s environmental health indicators 

updated annually, most recently in July 2008. internationally, an effort initiated at the World 

www.epa.gov/envirohealth/children Summit on Sustainable Development in 2002. 

The pilot phase of this work culminated in 

Some examples: an international workshop in Tunisia in April 

2008. Participants reviewed and assessed 

• Approximately 53 percent of U.S. chil- the progress made on developing the health 

dren lived in counties where ozone levels indicators based on reports prepared for 

exceeded National Ambient Air Quality North America, Europe, Argentina, Cameroon, 

Standards at least one day in 2006. (see Kenya, Oman, Tunisia, and Zimbabwe. Key 

chart below) conclusions from the workshop focused on 

next steps for improving and expanding chil-

• About 10 percent of children were served dren’s environmental health indicators, and 

by community water systems that exceeded reflected a strong commitment by all particia Maximum Contaminant Level or violated a pants to continue this work. The consensus 

treatment standard in 2006. of the workshop was that a small “core set” 

of indicators, representing common interests 

• The median concentration of lead in the and concerns across regions and nations, 

blood of children five years old and younger should be further developed by all countries. 

dropped from 15 micrograms per deciliter www.who.int/ceh/indicators/en/

70%

60%

50%

40%

30%

20%

10%

0%

Percentage of children living in counties where air quality standards were exceeded

Any standard

Ozone eight-hour standard

PM-10: Particles less than 10 micrometers 

in diameter

PM-2.5: Particles less than 2.5 micrometers 

in diameter

PM–2.5

Carbon

monoxide PM–10 SOURCE: U.S. EPA, America’s 

Children and the Environment 

Lead www.epa.gov/envirohealth/children

DATA: U.S. EPA, Office of Air and Radiation, 

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 Aerometric Information Retrieval System
En vironmental 

 health disparities

Children’s Environmental Health: 2008 Highlights 

22

Eliminating health disparities, the gap in morbidity and 

mortality between social groups (e.g. racial/ethnic minorities 

and low-income populations), is of great importance to promoting 

child health. Current research suggests that characteristics of social, physical, 

and built environments contribute to these disparities. For example, children in 

socioeconomically disadvantaged communities are disproportionately diagnosed 

with asthma. In fact, black children in America are twice as likely to be hospitalized 

for asthma and four times as likely to die from asthma as white children. Eight 

percent of Hispanic children have asthma, but there are big differences among 

ethnic groups. Puerto Rican children have the highest rates of asthma at 20 percent, 

compared with 7 percent for Mexican-American children.

Southeast Pediatric Environmental Fact Sheets: Tools are needed to identify 

Health Specialty Unit (PEHSU): The children who are most at risk and to underPEHSU conducted a research symposium on stand the cumulative impact of social and 

environmental health disparities in children. physical environments on children’s health. 

Break The Cycle is a collaborative, interdis- Feedback from users of EPA’s America’s 

ciplinary research and training program with Children and the Environment shows that 

faculty from southeastern universities mentor- information targeted for specific audiences 

ing students to develop projects that reduce is more effective than information aimed at 

or prevent environment-related illnesses. The general audiences. EPA’s new fact sheets 

program addresses issues such as obesity, reflect this by addressing disparities in sechealth effects of agricultural pesticides on ondhand smoke exposure and asthma among 

children of migrant farmers, childhood asthma, African-American and Hispanic-American 

disparities in girls’ pubertal development, and children. Each fact sheet includes information 

environmental justice awareness. Students in on actions that parents can take to protect 

diverse areas of study explore problems and their children, and positive actions EPA and 

solutions related to environmental health dis- other organizations are taking to address each 

parities. One case study on PCB contamina- environmental health issue. The intended audition in Anniston, Alabama, included a biology ences for these outreach materials are parseminar with 150 students at Spelman, a his- ents and community organizations working on 

torically black women’s college in Atlanta. The environmental health issues for specific minorresearch was presented at a workshop in May ity populations. These new fact sheets can 

at Emory University’s Rollins School of Public be found at http://yosemite.epa.gov/ochp/

Health. www.sph.emory.edu/PEHSU ochpweb.nsf/content/publications2.htm#2.
Les sons learned and the 

continued need for research

Children’s Environmental Health: 2008 Highlights 

23

A Decade of Research: In March 

2008, the National Center for Environmental 

Research (NCER) in EPA’s Office of 

Research and Development released the 

report A Decade of Children’s Environmental 

Health Research: Highlights from EPA’s 

Science to Achieve Results (STAR) Program. 

The report summarizes research from the 

program over the past 10 years, highlighting 

scientific findings in epidemiology, exposure 

science, genetics, community-based participatory research, interventions, statistics, and 

methods. This body of work has influenced 

policy and scientific research on children’s 

health in the United States and abroad. The 

report is available at http://es.epa.gov/ncer/

publications/research_results_synthesis/.

Translating Research Into Practice:

EPA, the National Institute for Environmental 

Health Sciences, the PEHSUs, and the 

Children’s Environmental Health Centers 

organized a workshop for a group of clinicians, researchers, and health advocates from 

academia, government, and nonprofit organizations to discuss ongoing research in children’s environmental health, issues in clinical 

A Decade of Children’s 

Environmental Health Research

Highlights from EPA’s 

Science to Achieve Results Program

Office of Research and Development

National Center for Environmental Research

SUMMARY REPORT

EPA/600/S-07/038 | December 2007 | http://www.epa.gov
Children’s Environmental Health: 2008 Highlights 

24

practice, and opportunities for translating sci- disciplines, perspectives, and biases on the 

entific findings. Topics included: evidence for a secular trend in puberty timing (i.e., change in the age of puberty over 

• Research on biomarkers for children’s expo- time) and the role of environmental factors 

sure to pesticides; in puberty timing in children. The articles 

review the expert panel conclusions and the 

• Pesticide exposures and neurodevelopment state of the science on the role of body fat, 

in children from farmworker families; endocrine disruptors, and other environmental 

chemicals in puberty onset and progression 

• IPM in urban housing; from both the animal and epidemiological 

literature. Several EPA scientists are authors. 

• Evidence concerning children’s exposure to http://pediatrics.aappublications.org/content/

phthalates (chemicals in many plastics) as vol121/Supplement_3/

potential endocrine disruptors;

Food Allergies: Approximately 

• Environmental management for asthma care 6–8 percent of children suffer from a food 

and prevention; allergy during their first three years of life. 

Many of these children go on to develop a 

• Outcomes of early life exposures to metals tolerance, and so the prevalence of food allerand neurotoxins; gies in adults is approximately 3 percent. The 

reasons why some children outgrow the dis-

• Transportation, the built environment, and ease and others do not are unclear. As with 

children’s health; other types of allergic diseases, the incidence 

of food allergy appears to be increasing and 

• The National Children’s Study (NCS); allergic individuals can experience life-threatening reactions. EPA has developed two com-

• Tools for recovery and communicating risks plementary mouse models for food allergy that 

to children in the aftermath of disasters suggest thresholds exist for induction of these 

such as Hurricane Katrina; and allergic responses. These models provide a 

means to explore underlying mechanisms for 

• The National Forum on Children and Nature, allergies and to understand the basis for suswhich is sponsoring demonstration projects ceptibility. http://toxsci.oxfordjournals.org/cgi/

addressing the issue of children’s isolation content/full/102/1/100

from nature. 

Children’s Inhalation Dosimetry 

Conference Summary, Agenda, Presentations and Health Effects for Risk 

and Proceedings Report: http://es.epa.gov/ Assessment: Understanding children’s 

ncer/childrenscenters/presentations/ risks due to exposure via the inhalation path10_10_07/10_10_07_workshop.html way is a special challenge. Children are different from adults and could experience different 

Environmental Factors and Puberty: exposures due to differences in dosimetry (i.e., 

Five articles based on the findings of the child-adult differences in respiratory/systemic 

workshop entitled “The Role of Environmental dose resulting from exposure to the same airFactors on the Onset and Progression of borne concentrations), child-specific behavior, 

Puberty” were published as a supplement to and different health effects based on their 

Pediatrics on Feb. 1, 2008. This workshop, growth and development. A special issue of 

sponsored by EPA, NIEHS, and Serono the Journal of Toxicology and Environmental 

International, was the first effort to evalu- Health (vol. 71, no. 3, 2008) includes sumate the data and come to consensus across mary manuscripts from the children’s 
Children’s Environmental Health: 2008 Highlights 

25

inhalation workshop that EPA hosted in 2006, NIEHS. This interagency coordination ensures 

as well as independent research articles on alignment with the Children’s Health Act of 

related topics contributed by workshop partici- 2000, which authorized the study. 

pants. This effort is the first to bring together 

the existing and emerging information on chil- Much progress has been made in the 

dren’s inhalation dosimetry, health effects, and past eight years. Twenty-two new Study 

risk assessment, and to explore and discuss Centers were announced to support the 

new approaches for children’s inhalation risk NCS in 26 communities in 2007; more 

assessment practice. will be announced in fall 2008. The first 

Study Centers are planning to enroll particiToxicity Testing: This past year, the pants in 2009. Recent reviews of the NCS 

National Academy of Sciences (NAS) released Research Plan by NAS and scientists in 

Toxicity Testing in the 21st Century: A Vision the lead agencies concurred that the study 

and a Strategy, funded in part by EPA. The goals and design are responsive to the 

report discusses how toxicity testing is poised Children’s Health Act. These reviews proto take advantage of advances in toxicog- vide a number of recommendations, some 

enomics, bioinformatics, systems biology, of which are being implemented and othepigenetics, and computational toxicology to ers that can be considered in the future. 

transform toxicity testing. The NAS report pro- www.nationalchildrensstudy.gov

vides a blueprint for this paradigm shift. 

International Childhood Cancer 

National Children’s Study (NCS): Cohort Consortium (I4C): Childhood 

Patterns of illness in children have changed cancer is a devastating disease. Fortunately, 

substantially in the last 100 years. Infectious the number of children with the disease is so 

disease and sanitation used to be major risks small that a very large sample size is required 

to children’s health. Today it is not uncommon to study it. Around the world, several large 

to know a child with a chronic condition such infant and child prospective studies have been 

as asthma, autism, or obesity. The extent to launched to examine environmental and biowhich environmental factors can influence the logical determinants of common diseases. The 

incidence of these diseases is not well under- I4C was established in 2005 as a global allistood. The NCS will answer important ques- ance of longitudinal studies to enable investitions related to the environment and health, gations of the role of environmental exposures 

and will provide the foundation for government in the etiology of childhood cancer. Because 

policy, medical practice, and individual deci- of its longitudinal design and large sample 

sions that will improve the overall health of size, it will be easier to see associations 

children. The NCS will look at how the envi- considered statistically meaningful. Initially, 

ronment interacts with genetics and other fac- this effort could provide insights about the 

tors to influence the health and development causes of childhood leukemia, and later could 

of 100,000 children in 105 locations across be helpful for studying other types of canthe United States. Children included in the cer as well as other rare childhood diseases. 

study will proportionately represent the geo- Protocols have been developed to examine 

graphic, ethnic, and economic diversity of the the feasibility of combining data from studies 

nation’s children. from around the world. EPA supported two 

workshops, in 2005 and 2007. See more at 

The NCS is a result of collaboration by four www.nationalchildrensstudy.gov/. 

lead federal agencies: the Eunice Kennedy 

Shriver National Institute of Child Health and 

Human Development (the study’s home at the 

National Institutes of Health), EPA, CDC, and 
Pe diatric environmental 

 health specialty units

PEHS

Pediatric Environm

U

ental

Health Specialty Units

A unique partnership between EPA and conditions related to environmental factors. 

the Agency for Toxic Substances and The need for pediatric environmental health 

Disease Registry (ATSDR) has completed its expertise exists worldwide, and the PEHSU 

10th year. Both agencies support the PEHSU model is being adopted by other countries. 

program, which provides education and con- Highlights from the PEHSUs include creation 

sultation to health care providers, officials, of fact sheets on wildfires and bisphenol A; 

and the community through their network of participating in a Spanish webcast on lead 

more than 100 physicians, nurses, toxicolo- poisoning; a successful effort to limit exposure 

gists, and social workers in the United States, to secondhand smoke in Tyler, Texas; working 

Canada, and Mexico. PEHSUs are a source with colleagues in Chile to assist in creatof information and advice on environmental ing a PEHSU in Santiago; addressing issues 

conditions that influence children’s health. in child-care centers by working with the 

PEHSUs are academically based, typi- Children’s Environmental Health Network; and 

cally at university medical centers, and work creating a satellite PEHSU in Cincinnati, Ohio. 

together as a network capable of responding www.pehsu.net

to requests regarding prevention, diagnosis, 

management, and treatment of childhood 

Children’s Environmental Health: 2008 Highlights 

26
En vironmental health for 

 health care providers

Many children’s health problems resulting from environmental exposures can be 

prevented, and need to be diagnosed, managed, and treated. While the public 

looks to health professionals for this, most are not educated on environmental 

precipitants of disease. The Institute of Medicine published two studies in the 1990s 

recommending that a greater effort be made to incorporate environmental health 

concepts into the training of health professionals. 

Prenatal Environmental Health: EPA • The Inter-Tribal Council of Michigan, Inc. 

recently awarded grants to address envi- will address tobacco smoke, mercury, lead, 

ronmental health issues during the prenatal and drinking water contaminants to Native 

period. Grantees will educate pregnant women American women of child-bearing age. 

about environmental health risks, demonstrate 

the effectiveness of information dissemination • The Oregon Department of Human Services 

and behavior change, and increase the num- aims to increase knowledge and promote 

ber of health professionals fluent in prenatal behavior change among pregnant women 

environmental health issues. who are exposed to mercury, lead, secondhand smoke, chemicals, pesticides, contaminated drinking water, and work- and 

hobby-related environmental hazards. 

Children’s Environmental Health: 2008 Highlights 

27
Children’s Environmental Health: 2008 Highlights 

28

• In Pennsylvania, the Philadelphia Other grantees include:

Department of Health will develop training 

and education programs for health care • Canadian Institute of Child Health in 

providers and pregnant women on environ- partnership with the Asociación Argentina 

mental health risks of prenatal exposure to Médicos por el Medio Ambiente and 

secondhand smoke and lead poisoning. Argentine Society of Doctors for the 

Environment

• The Ohio Department of Health will develop 

and implement an easy-to-use environ- • National Environmental Education 

mental risk profile focusing on second- Foundation

hand smoke, lead, mercury, radon, carbon 

monoxide, indoor pesticides, and other • Greater Boston Physicians for Social 

environmental toxics that can adversely Responsibility

affect birth outcomes. 

• International Pediatric Association

• The Duval County [Florida] Health 

Department will develop training programs • KSOHIA Collaboration of medical and pubfor physicians, prenatal care providers, and lic health universities in Kansas, Ohio, Iowa, 

Healthy Start staff on environmental health and six Eastern European countries. 

risks of prenatal exposure to methylmercury, 

lead, secondhand smoke, and drinking water These grants support education and traincontaminants. ing of health professionals on environmental 

health issues. As a result of the train-theHealth Care Provider Grants: More trainer approach and the online tools develthan 9,000 health professionals were trained oped, incorporating environmental health into 

to address environmental health concerns health care provider education and practice 

as a result of projects funded by EPA. The will continue to expand beyond the life of 

University of Massachusetts Lowell educated these grants.

health professionals with a combined client base of 60,000 children in the six New 

England states. Positive changes occurred in 

individual professional practice and organizational policy in these states, including nurseled efforts to enact anti-idling legislation and 

incorporation of environmental health into 

public health nurse education. Another effort, 

by the National Center for Healthy Housing, 

brought together housing and health officials. 
Children’s Environmental Health: 2008 Highlights 

29

Ch ildren’s environmental

health excellence awards

Dr. Ruth Etzel, an internationally known epidemiologist, pediatrician, and 

environmental health specialist, was the 2007 Children’s Environmental Health 

Champion. Dr. Etzel was recognized for 20 years of work and for driving the effort 

to emphasize the critical importance of children’s environmental health for health 

professionals. She founded and served as editor of the first and second editions 

of the American Academy of Pediatrics’ Pediatric Environmental Health. Working 

with the Ambulatory Pediatric Association, Dr. Etzel helped launch the first Pediatric 

Environmental Health Fellowships in the United States in 2001. Most recently she 

worked with the International Pediatric Association to launch a virtual International 

Pediatric Environmental Health Leadership Institute.

#HAMPION

2007 Excellence Award winners:

• The Asociación Argentina Médicos por • Magee-Women’s Hospital of the 

el Medio Ambiente , on behalf of the University of Pittsburgh Medical Center, 

International Society of Doctors for Magee Environmental Health Initiatives, 

the Environment, Building Children’s Pittsburgh, PA 

Environmental Health Capacity Among 

Health Care Professionals in the Southern • National Center for Healthy Housing, 

Cone, Buenos Aires, Argentina Pediatric Environmental Home Assessment 

Online Training, Columbia, MD

• Association of Occupational and 

Environmental Clinics, PEHSU program, • Northwest Pediatric Environmental Health 

Washington, DC Specialty Unit, University of Washington, 

Seattle, WA

• Asthma Regional Council of New England, 

a program of the Medical Foundation of • Procter & Gamble Company, P&G Live, 

Boston, Environmental Investments Project, Learn and Thrive/Children’s Safe Drinking 

Dorchester, MA Water, Cincinnati, OH 

• Children’s Hospital of Pittsburgh Pediatric • EPA, National Exposure Research 

Residency Program, Pediatric Environmental Laboratory, Research Triangle Park, NC

Health Curriculum, Pittsburgh, PA

• Los Angeles Unified School District, 

Office of Environmental Health and Safety, 

Safe School Inspection Program, Los 

Angeles, CA 
Conclusion

The environment clearly affects the health of children. Some environmental health 

issues are daunting in their scope, such as the effects of global climate change on 

the health of the world’s children. Some problems mock us with their persistence, 

such as the disproportionate effects of exposure on minority and poor children. Some 

challenges are inevitable, such as natural disasters and their environmental health 

consequences. These concerns, together with the longstanding mission to clear our air, 

filter our water, restore the land, safely grow our food, remove waste, and treat sewage, 

require our continued commitment and collaboration with many diverse partners. 

EPA will continue to safeguard the health of children through its efforts to develop 

sound science, issue protective regulations, and raise awareness to create a healthy 

environment so that current and future generations continue to thrive.

Office of Children’s Health Protection and Environmental Education 

www.epa.gov/children
Office of Children’s Health Protection and Environmental Education 

Child and Aging Health Protection Division (1107A)

1200 Pennsylvania Avenue, NW

Washington, DC 20460

Official Business

Penalty for Private Use $300

For more information, visit:

www.epa.gov/children

Office of Children’s Health Protection and Environmental Education 

Child and Aging Health Protection Division (1107A)

Recycled/Recyclable—Printed with vegetable oil based inks on paper that contains at least 50% post consumer fiber.

Office of Children’s Health Protection and Environmental Education EPA-100-K-08-004 www.epa.gov October 2008

Child and Aging Health Protection Division (1107A)